\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on “All Things Considered,” Marketplace, the BBC, “99% Invisible,” and “Reveal” from the Center for Investigative Reporting.\t\t<\/p>\n
\n\t\tCredits\t<\/h3>\n
\tEmily Pisacreta
\n\tHost<\/p>\n
\tEllen Weiss
\n\tEditor<\/p>\n
\tAdam Raymonda
\n\tAudio wizard<\/p>\n
\tJanmaris Perez
\n\tProducer<\/p>\n
\tLauren Gould
\n\tProducer<\/p>\n
\t\t\t\t\tClick to open the Transcript\t\t\t\t<\/p>\n
\t\t\t\t\t\tTranscript<\/strong>: The Struggle To Afford Insurance in 2026 Hits Home<\/strong>\t\t\t\t<\/p>\nNote: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\nDan:<\/strong> Hey there\u2013<\/p>\nOver the summer, our pals at KFF Health News published a story with the headline: \u201cInsurers and customers brace for double whammy to Obamacare premiums.\u201d<\/p>\n
Basically\u2013 whammy number one \u2014 insurers are planning to raise premiums for 2026 \u2014<\/p>\n
And whammy number two: federal subsidies for Obamacare policies are scheduled to get a lot less generous.\u00a0<\/p>\n
Together, these whammies mean millions of people will be looking at paying a LOT more every month \u2014 like hundreds of dollars more.\u00a0<\/p>\n
Folks are going to need as much advance warning as possible, to figure out how to prepare for a hit like that.<\/p>\n
Meaning: This is our kind of story.\u00a0<\/p>\n
And this one hits a little close to home. Because one of those folks is An Arm and a Leg\u2019s senior producer, Emily Pisacreta.<\/p>\n
Emily:<\/strong> Yeah, it\u2019s a wild time. I\u2019ve never had to do this before. Cuz I\u2019ve always had health insurance through work. I\u2019ve totally shaped my life around that because I have diabetes, and without health insurance, I can\u2019t afford what I need.<\/p>\nDan:<\/strong> But that health insurance has never come from An Arm and a Leg. When Emily started working here as an intern, she was the first person besides me to work more than a few hours a week. We didn\u2019t have an employee health plan because we didn\u2019t have employees.<\/p>\nAnd we\u2019re still so tiny, so tiny. Apart from summer interns, there\u2019s still only ever been one other person working more than a few hours a week besides the two of us. I\u2019m still the only full-time person, and we still don\u2019t have an employee health plan.<\/p>\n
Emily:<\/strong> And until recently, that worked for me\u2013 I had another part-time job, and it had health benefits.<\/p>\nExcept my contract with that job just ended.\u00a0<\/p>\n
So for the first time, like more than 20 million other people, I\u2019m looking at open enrollment. And I gotta say, it\u2019s one hell of a year to do that.\u00a0<\/p>\n
Dan:<\/strong> You\u2019re a double-whammy case study.\u00a0<\/p>\nAnd to get a broader perspective, the two of us talked with Julie Appleby, the reporter who wrote that \u201cdouble-whammy\u201d story, and since then you\u2019ve continued to do more homework.\u00a0<\/p>\n
Emily:<\/strong> It\u2019s been pretty intense!\u00a0\u00a0<\/p>\nDan:<\/strong> For real. And I\u2019m a little bit of a case study too:<\/p>\nSuddenly I\u2019m finding out what our country\u2019s \u201csystem\u201d \u2014 where health insurance gets tied to jobs \u2014 looks like \u2026 from the employer side. It\u2019s a whole new adventure.\u00a0<\/p>\n
We don\u2019t know exactly what we\u2019re going to do. Honestly, I don\u2019t think anybody does.<\/p>\n
But we\u2019ve learned a ton. About what we\u2019re up against \u2014 along with millions of other people \u2014 and our options.<\/p>\n
And by tackling this right now \u2014 six weeks before open enrollment starts \u2014 I hope we can help a lot of other people start planning early with solid information. Let\u2019s go.<\/p>\n
This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann. I\u2019m a reporter, and I like a challenge. So the job we\u2019ve picked on this show is to take one of the most enraging, terrifying, depressing parts of American life, and bring you a show that\u2019s entertaining, empowering, and useful.<\/p>\n
So, we started by checking in with the person whose reporting first got us looking at this story.<\/p>\n
Julie Appleby:<\/strong> It\u2019s recording. It looks like it says 10, 11,<\/strong><\/p>\nDan in interview:<\/strong> perfect.<\/strong><\/p>\nJulie Appleby:<\/strong> I have notes and I\u2019ll try not to rattle the papers.\u00a0<\/strong><\/p>\nEmily in interview:<\/strong> I mean, if we have a reporter on tape rattling papers, I feel like that\u2019s probably okay.<\/strong><\/p>\nJulie Appleby:<\/strong> Okay. That\u2019s a plan, man.<\/strong><\/p>\nEmily in interview:<\/strong> Yeah. Why don\u2019t we start out, could you just like, tell us your name and what you do and where you work?<\/strong><\/p>\nJulie Appleby:<\/strong> So this is Julie Appleby. I\u2019m senior correspondent at KFF Health News.<\/strong><\/p>\nEmily in interview: <\/strong>What sort of stuff do you cover?<\/strong><\/p>\nJulie Appleby:<\/strong>\u00a0 I cover healthcare policy, but that\u2019s a broad term. So everything from cost to, the Affordable Care Act, to what\u2019s going on with Medicare, all kinds of different things involving health care programs and insurance.<\/strong><\/p>\nEmily in interview:<\/strong> So we were really excited to talk with you, because we wanted to cover, you know, all the changes to the marketplace plans, that you\u2019ve been writing about. And, it just so happens that I need to enroll in a marketplace plan.<\/strong><\/p>\nJulie Appleby:<\/strong> So let\u2019s give you kind of the rundown. There\u2019s like, there\u2019s kind of like two things going on here. One of them is that just premiums are going up as they do every year. Although this year it\u2019s bigger than it\u2019s been since 2018. So the median increase nationwide, and this is according to some data research by KFF, is about 18%. So that\u2019s a big jump, right?\u00a0<\/strong><\/p>\nEmily in interview:<\/strong> Yeah. Yeah. In your reporting you called it a double whammy. Rates are going up, enhanced subsidies are probably going away.\u00a0<\/strong><\/p>\nJulie Appleby:<\/strong> Right. That\u2019s the second half of the double whammy.<\/strong><\/p>\nDan:<\/strong> OK, breaking in here\u2013 gonna do this a couple of times for Obamacare vocabulary. Emily just mentioned an important term, went by kinda fast: enhanced subsidies. Obamacare has always included subsidies for most people \u2014 that\u2019s part of the \u201cAffordable\u201d part of Affordable Care Act. But for lots of people, Obamacare policies still were\u2026 pretty expensive!<\/p>\nSo, in 2021 \u2014 like, as part of a COVID recovery package \u2014 Congress added extra subsidies for Obamacare policies: Enhanced subsidies.\u00a0<\/p>\n
Julie Appleby:<\/strong> Basically, they made the coverage more generous on both ends of the income spectrum. In fact, I think I was looking at some statistics this morning and something like, 80% of people who have coverage right now have a plan that\u2019s $10 a month or less.<\/strong><\/p>\nDan:<\/strong> These are folks with lower incomes \u2014 where paying sixty or eighty dollars a month is a big bite. With \u201cenhanced\u201d subsidies, that became ten dollars \u2014 or even zero.<\/p>\nBut people with higher incomes also got help. Before the enhanced subsidies, people with incomes above a certain level didn\u2019t get ANY subsidy. People called it an \u201cincome cliff.\u201d<\/p>\n
For the last four years these enhanced subsidies, kind of erased that cliff. If your income was higher, you just paid a percentage of your income. Enhanced subsidies picked up the rest.<\/p>\n
But the enhanced subsidies weren\u2019t permanent. They\u2019ll expire at the end of this year, unless Congress extends them. Otherwise\u2026\u00a0<\/p>\n
Julie Appleby:<\/strong> people who make more than the four times the federal poverty level will not qualify for any help with their premiums under the Affordable Care Act. There will be that cliff.<\/strong><\/p>\nEmily in interview:<\/strong> Right, right.\u00a0<\/strong><\/p>\nDan:<\/strong> And it turns out Emily is basically standing on that cliff. She shows Julie the numbers.<\/p>\nEmily:<\/strong> We found this calculator from KFF that attempts to show the changes in premiums if the subsidies expire. And maybe I\u2019ll just share my screen and we can look at \u2013 we can look at what I\u2019m looking at.<\/strong><\/p>\nOkay, you guys see KFF? Maybe just reload and I can enter some Emily figures in here. So, they ask you about where you live and your yearly household income.\u00a0<\/strong><\/p>\nDan in interview:<\/strong> what\u2019s the amount that you\u2019ve entered as income?<\/strong><\/p>\nEmily in interview:<\/strong> I have entered $63,000. And it says, without enhanced subsidies, you will likely lose financial help. Because my income is 418% of the federal poverty level.<\/strong><\/p>\nDan:<\/strong> <\/strong>Oy. a little more Obamacare vocabulary. First: Federal poverty level. Four times that level is where you fall off the income cliff, no subsidies. 400 percent. And the calculator \u2013 which we should say, is a year out-of-date, so the numbers aren\u2019t precise, but they give us an idea\u2013 that calculator says Emily\u2019s at 418.<\/p>\nAnd next: \u200aObamacare plans come in different \u201clevels,\u201d like Olympic medals: Bronze, Silver, Gold\u2026 Bronze plans are the cheapest, and cover the least.\u00a0<\/p>\n
If Emily got a subsidy, the calculator says a silver plan would be like 400-and some dollars a month, but it says Emily wouldn\u2019t GET a subsidy, so\u2026\u00a0<\/p>\n
Emily in interview:<\/strong> It would be about $880 a month for a silver plan, or $675 a month for a bronze plan. So for me, that is stressful to read.\u00a0<\/strong><\/p>\nJulie Appleby:<\/strong> That\u2019s a lot of money. 880 bucks a month.<\/strong> So you\u2019re in the situation where you don\u2019t get any, subsidies because your income is over that amount. But I played around with one of these calculators too when I wrote a story recently. And I also plugged in somebody, let\u2019s say who\u2019s earnings are kind of at the lower end of the income scale, say just over 150% of the federal poverty level. So they\u2019re still gonna pay more. They\u2019re, it\u2019s gonna go from paying sort of a national average of about $2 a month to 72 bucks a month, or $864 a year. And remember, this is somebody who\u2019s making 23,000 a year. So $864 is a lot of money.\u00a0<\/strong><\/p>\nDan in interview:<\/strong> Emily, can you put that calculator back up on the screen for us?<\/strong><\/p>\nEmily in interview:<\/strong> Sure can.<\/strong><\/p>\nDan in interview:<\/strong> The scary calculator. I mean, what would happen if your income were just a little bit lower? If you just shave $3,000 from your income, what does it look\u00a0<\/strong><\/p>\nEmily in interview:<\/strong> So maybe like 60?\u00a0<\/strong><\/p>\nJulie Appleby:<\/strong> I bet you could even shave a little bit less. Why didn\u2019t you make it 62?<\/strong><\/p>\n\u00a0(Sfx: Buzzer)\u00a0<\/p>\n
Dan:<\/strong> How about 61? What does 61 do for us?<\/strong><\/p>\nEmily in interview:<\/strong> Can I get a 61\u00a0<\/strong><\/p>\n(SFX: Buzzer)<\/strong>\u00a0<\/strong><\/p>\n\u00a0<\/strong>Dan:<\/strong> how about $60,500?<\/strong><\/p>\n\u00a0<\/strong>(SFX: Buzzer)<\/strong>\u00a0<\/strong><\/p>\nDan in interview:<\/strong> I feel like this is like an auction reverse.<\/strong><\/p>\nJulie Appleby:<\/strong> in reverse.<\/strong><\/p>\nEmily in interview:<\/strong> I know this is like the auction from hell<\/strong><\/p>\nDan in interview:<\/strong> Yeah, we\u2019re, we\u2019re lowering your income. So let\u2019s keep going. $60,200,<\/strong><\/p>\n\u00a0<\/strong>(SFX: Ding!)<\/strong>\u00a0<\/strong><\/p>\nDan in interview:<\/strong> That is it. Holy crap it\u2019s a giant cliff. It\u2019s a $5,000 cliff<\/strong><\/p>\nDan<\/strong>: <\/strong>Breaking in one last time:\u00a0 Five thousand dollars is how much money Emily might save on Obamacare premiums if her income stays below that 400 percent line.\u00a0 Put another way: It\u2019s how much more she\u2019d have to pay if she steps over that cliff.<\/p>\nDan in interview: <\/strong>Julie, what does that look like to you, seeing that?<\/strong><\/p>\nJulie Appleby:<\/strong> I think this also, this illustrates a lot of things. I mean, people are gonna have to keep in mind that cliff for next year if these tax credits aren\u2019t extended. This is a projection, this is what you think you\u2019re going to earn next year. So that\u2019s one thing that to keep in mind, okay? And something could happen. Emily could, I don\u2019t know, maybe she wins the lottery or she goes to the casino and wins a bunch of money and that puts her over.\u00a0<\/strong><\/p>\nEmily in interview:<\/strong> Or offers me, you know, a freelance job that\u2019s really interesting. It doesn\u2019t pay that much, but just puts me over, you know?\u00a0<\/strong><\/p>\nDan in interview:<\/strong> You have to say, I\u2019m sorry, that freelance job is gonna cost me more than $5,000 to accept.<\/strong><\/p>\nDan: <\/strong>So, Emily: listening back to that conversation now. What are you feeling?<\/p>\nEmily:<\/strong> I mean, I was trying to stay calm but internally I was freaking out. As Gen Z likes to say, I was crashing out.<\/p>\nDan:<\/strong> It was really emotional. We both needed time to cool off, just to put this story together.<\/p>\nEmily:<\/strong> Yeah, this situation is stressful. I don\u2019t know for sure how much money I\u2019m even going to make next year. And it feels kind of weird to put all this out here. I don\u2019t know how any of this sounds to other people. Because maybe it sounds like 400% of the federal level is a lot of money. And in some parts of the country it definitely is. But I live in New York City. So my income doesn\u2019t go that far. And that $880 bucks a month we were talking about? That\u2019s actually a big hit.\u00a0<\/p>\nDan:<\/strong> Yeah and \u2014 not to pile on, but: the data behind the calculator where we got that number, 880 \u2014 that\u2019s last year\u2019s data.\u00a0 So it doesn\u2019t include the big premium increases that Julie was writing about. The actual amount you\u2019d\u00a0 be paying every month would be bigger. And you looked up the deductible: more than four thousand dollars.\u00a0<\/p>\nEmily:<\/strong> Right, which I won\u2019t have lying around at the beginning of next year either. Yeah so honestly, all of it still makes me want to scream.\u00a0<\/p>\nDan:<\/strong> Yeah, and you\u2019re a case study for a LOT of people. Julie read us a really sobering number, where one consulting group estimated that with this double-whammy Obamacare enrollment could drop by like half or more.\u00a0<\/p>\nAnd, in fact, one of the reasons insurers say they\u2019re raising prices this year is\u2013 without the enhanced subsidies, they figure a lot of healthy people will just opt out.\u00a0<\/p>\n
Emily:<\/strong> \u200aI can see why people don\u2019t sign up. I mean,\u00a0 I don\u2019t have that choice. But in order to get a subsidy, I\u2019d have to lower my income, and to a very specific number \u2013 which is less than I live on now. And watch it to make sure I don\u2019t take in a penny more.\u00a0<\/p>\nDan:<\/strong> While still paying hundreds of dollars a month for Obamacare\u200a\u2013 even with a subsidy.<\/p>\nEmily:<\/strong> And look. This is a thing a lot of people do. All the time. \u2013intentionally limit their income to qualify for assistance.. To keep Medicaid, people skip out on jobs, careers, marriage.\u00a0<\/p>\n\u200aSo my situation is NOT unique. It\u2019s definitely not the worst.<\/p>\n
Dan:<\/strong> You\u2019re our in-house case study. You can\u2019t stand in for everybody.<\/p>\nI mean, just to add one more wrinkle: If you didn\u2019t live in a super-expensive city, your premiums would actually be lower..<\/p>\n
I used that calculator to look up what you\u2019d pay for a silver plan in \u2026 Chicago, like where I live? Way, way cheaper. Like, unsubsidized? A lot less than a New York plan *with* a subsidy. I\u2019m just saying.<\/p>\n
Emily:<\/strong> That\u2019s\u2026 wild. No shade on Chicago But I don\u2019t think I\u2019m ready to make a long distance\u00a0 move for health insurance yet.<\/p>\nDan:<\/strong> I\u2019m just saying\u2026\u00a0<\/p>\nEmily:<\/strong> But while we\u2019ve been looking ahead to 2026 insurance, I\u2019ve actually had a more-immediate decision to make.<\/p>\nDan:<\/strong> Right.<\/p>\nEmily:<\/strong> LIke I said before, I had insurance through my old employer. <\/strong>But that\u2019s ending. While we were doing this story, I had to figure out health insurance for the last three months of 2025.<\/p>\nDan:<\/strong> You ended up getting some help from a real expert.<\/p>\nEmily:<\/strong> I sure did.<\/p>\nDan:<\/strong> And: I called up An Arm and a Leg\u2019s insurance broker.<\/p>\nBecause like we said: If Emily\u2019s a case study, so am I. We\u2019re so small, and I\u2019m the only one here who\u2019s needed health insurance from this tiny little enterprise. Now, things are a little different.<\/p>\n
What we\u2019ve learned, and what\u2019s next. That\u2019s just ahead.<\/p>\n
This episode of An Arm and a Leg is produced in partnership with KFF Health News. That\u2019s a nonprofit newsroom covering health issues in America. Their journalists \u2014 like Julie Appleby \u2014 do amazing work. We\u2019re honored to be their colleagues.<\/p>\n
Emily:<\/strong> Julie Appleby left me with a little advice: Connect with an ACA navigator.<\/p>\nDan:<\/strong> Navigators: These are folks who can guide you through the process of signing up for Obamacare. They\u2019re not brokers, they don\u2019t make a commission. They\u2019re paid by the government.\u00a0<\/p>\nEmily:<\/strong> But they\u2019re not government employees \u2014 local organizations work on government-funded contracts.<\/p>\nDan:<\/strong> Which makes sense\u2013 Obamacare plans themselves are basically local: The menu of plans to pick from, they don\u2019t just vary from state to state: They can be different from one county to another.<\/p>\nEmily:<\/strong> And I wanted a little perspective on how the whole navigator program works.<\/p>\nDan:<\/strong> And it turns out: We know someone at the organization that coordinates all the navigators in New York state.<\/p>\nElisabeth Benjamin:<\/strong> My name is Elizabeth Benjamin. I\u2019m Vice President for Health Initiatives at the Community Service Society of New York.<\/strong><\/p>\nDan:<\/strong> We\u2019ve spoken with Elisabeth before \u2014 a bunch of times \u2014 about her work pushing hospitals in NY to quit suing people over medical debt.<\/p>\nAnd yes, it turns out her shop also runs the network of navigators throughout New York.<\/p>\n
Emily:<\/strong> But when we talked, it turned out, her connection to the navigator program is a little different than I\u2019d expected.<\/p>\nElisabeth Benjamin:<\/strong> I don\u2019t, you know, run it day to day, but I, myself do help people individually enroll. Because it\u2019s really important to understand what people are experiencing, what their concerns are. I have like a small group of people that I help every year, Lots of friends, children.<\/strong><\/p>\nEmily in interview:<\/strong> Oh, that\u2019s awesome. Okay. Yeah, I bet you\u2019re like a great like auntie to have..<\/strong><\/p>\nElisabeth Benjamin:<\/strong> You know, people that turn 26 and the parents are like, I know, please, will you help me?<\/strong><\/p>\nEmily:<\/strong> She was like: Look, everybody needs help.<\/p>\nElisabeth Benjamin:<\/strong> The bottom line is, you know, it isn\u2019t for the faint of heart. It is hard to work through these websites. I mean, they are as user friendly as possible, but there\u2019s like little kind of little moguls that you have to kind of ski over and it\u2019s easy to kind of miss a mogul and faceplant, and we don\u2019t want that to happen.<\/strong><\/p>\nEmily:<\/strong> And when I told her about how my story fits into this episode, she was immediately like.<\/p>\nElisabeth Benjamin:<\/strong> Oh, well, I can help you.<\/strong><\/p>\nEmily:<\/strong> Not with my whole 2026 dilemma: there\u2019s just no information about 2026 plans out there yet. But for my immediate question \u2014 what do I do about the rest of 2025 \u2013 she was like, I\u2019m pretty free tomorrow.<\/p>\nElisabeth Benjamin:<\/strong> You can tape your enrollment.<\/strong><\/p>\nEmily in interview:<\/strong> Oh my gosh, that would be amazing.<\/strong><\/p>\nDan:<\/strong> Seriously amazing. I mean, it sounded like good tape, which we always like.\u00a0<\/p>\nBut also \u2014 we talked that day, you and me: You were really weighing some big decisions.\u00a0<\/p>\n